Four months ago, Gavin and Owen Cassellius were locked in a survival struggle in their mother’s womb. Tethered to a shared placenta, one was receiving too much of the blood supply and growing ounce by ounce, while the other was withering and struggling to thrive.

You wouldn’t know it to look at them now. Pink and perfect, the identical twins — born Wednesday at 5 pounds, 9 ounces and 5 pounds, 4 ounces — slept quietly Friday as their parents explained the new surgery in Minnesota that gave them a fighting chance.

“Indescribable, I guess,” said new mother Jeana Cassellius.

“A miracle, essentially,” said new father Jeff Cassellius, “to be here holding both of them.”

Jeana Cassellius was diagnosed in her 19th week of pregnancy with twin-to-twin transfusion syndrome, an imbalance that occurs when identical twins share a placenta and one chronically loses blood to the other. Often, neither child survives. The “donor” child can become dehydrated and weak, while the “recipient” can swell and develop heart failure because of overwhelming blood volume.

Treatment options are limited for this complication, which occurs in 3 percent of all twin pregnancies. Doctors can drain fluid from the uterus to reduce pressure on the babies, but this also increases the risk of premature birth. Doctors also can perform a selective termination of one fetus to enhance the survival chances of the other, but that, too, presents risks and emotional hardships.

So doctors at Abbott Northwestern Hospital in Minneapolis and Children’s Hospitals and Clinics of Minnesota sought a new hope — one that hadn’t been tried in Minnesota until this year. Called fetoscopic laser ablation, the procedure involves threading a tiny laser light into the uterus and using it to sever the shared vessels that are causing the imbalance in blood flow.

This twin-to-twin complication happens roughly 40 to 50 times a year in Minnesota, and parents in the past have had to pursue the limited options locally or travel out of state for the surgery. The absence of this surgical option was troubling to Drs. William Block and Brad Feltis, especially when babies die in 80 percent to 90 percent of these cases without treatment.

“It pushed Brad and (me) to feel like we needed to be able to offer that here,” Block said.

Feltis and Block performed Jeana Cassellius’ operation July 3, after traveling to Belgium to learn the technique.

Studies have shown that 35 percent to 40 percent of these surgeries save both twins and 75 percent to 90 percent of the surgeries save at least one twin. Neurological impairments can occur for up to 8 percent of the surviving newborns, though, and the deaths of both babies still occur in up to one in four cases.

The surgery also carries some risk of inducing an early delivery. It also presents challenges for the surgeons who have to sever blood vessels no larger than a strand of hair or toothpick while the babies are moving around.

“They’re frequently getting in our way,” Feltis said, “and we have to gently move them aside.”

The doctors then watched closely to see if the blood flow and fluid levels returned to normal, and whether the growth rate of both babies returned to an even pace.

“Really, within about 48 hours we start to see those corrections,” Block said.

The Casselliuses hope to return home to Roberts, Wis., this weekend — with the normal apprehension of first-time parents. Jeff Cassellius is a personal trainer. Jeana Cassellius will be taking maternity leave from her customer service job.

Each step following surgery brought a bit more relief — first, when Jeana Cassellius recovered; then when the operation appeared successful; and when the babies survived to 24 weeks’ gestation, 30 weeks and beyond. They were born at 36 weeks, near full term.

“When you finally see them,” Jeff Cassellius said, “you think, ‘OK, now you can breathe. Everything’s fine. Now, you are not worried anymore.’ ”

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